CNM · California
Collaborative Practice Agreement for Certified Nurse-Midwives in California
Not unconditionally. California does not name a specific instrument.
Unusually, autonomy is triggered by a clinical DEFINITION, not an hours/years threshold (contrast `np`) — enacted by SB 1237 (2020, eff. ~2021). Distinct from California's separate, non-nurse 'Licensed Midwife' (LM) credential (§2505 et seq., Medicine chapter, regulated by the Medical Board) — LMs DO practice under physician supervision; don't conflate the two.
Independent practice requires: Practice falls within the codified 'low-risk pregnancy and childbirth' definition (Bus. & Prof. Code §2746.5(a)): single fetus, cephalic presentation, gestational age 37-42 weeks, spontaneous or induced labor, no preexisting condition the CNM cannot independently manage — within this definition, NO physician agreement or supervision is required at all.
What the collaboration must look like
The rules the physician relationship has to follow. Each fact comes from the statute or board rule listed under sources.
Proximity
No proximity requirement
No physical-proximity/radius requirement is codified for either the low-risk (no agreement at all) or out-of-scope (protocol-based) branch — protocols need only be 'mutually agreed upon' and signed, with no geographic term found.
Supervision ratio
Not codified — no cap on file
Chart review
Not codified — left to the agreement
Meeting cadence
Not codified — left to the agreement
Prescriptive authority
Covered by the practice agreement · controlled substances permitted
Bus. & Prof. Code §2746.51: CNMs may furnish/order Schedule II-V controlled substances 'incidentally to' maternal/newborn care. Schedule II/III require protocols addressing the diagnosis justifying the medication. Requires a BRN furnishing number, specific pharmacology coursework (including opioid-addiction and neonatal-abstinence-syndrome risk), DEA registration, and CURES registration — same 12-month/24-hour/6-month CURES framework as `pa`/`np` (Health & Safety Code §11165.4).
Written agreement
Not required
'Not required' reflects the low-risk scope, which is the CNM's core/default practice population — Bus. & Prof. Code §2746.5(k) confirms 'mutually agreed-upon, signed policies and protocols' are NOT required for services within that definition. For care OUTSIDE it (or a patient with a prior cesarean), §2746.5(b) requires signed protocols with a physician; absent them, the patient must be transferred (with a narrow post-42-week exception). §2746 separately requires CNMs to affirmatively disclose to patients that they are 'not supervised by a physician' — itself confirming the non-supervised default.
Practice ownership (corporate practice of medicine)
Licensee-only ownership required — Same nursing-corporation framework as `np` — a CNM (an RN with added certification, not a separate license) qualifies as a 'licensed person' in their own right and can majority- or wholly-own a nursing corporation delivering midwifery/birth-center services. Distinct from the non-nurse 'Licensed Midwife' (LM), who is reportedly limited to a MINORITY (≤49%) shareholder role — LM is one of 11 allied-professional categories eligible for minority ownership under Corp. Code §13401.5(f), confirmed via direct fetch (subsection letter and category count independently verified, superseding the original secondary-sourced '12' figure).
Corp. Code §13401.5(f)'s subsection letter and RN/NP ≥51% structure are now confirmed via a dedicated follow-up fetch — no longer purely secondary-sourced.
Legal sources for these rules (7)
- Bus. & Prof. Code §2746.5 — Low-risk practice definition, autonomy trigger, protocol requirement for out-of-scope care
- Bus. & Prof. Code §2746.51 — CNM furnishing/prescriptive authority
- Bus. & Prof. Code §2746 — Patient disclosure requirement (not independently fetched verbatim, only seen via search snippet — recommend direct fetch)
- Bus. & Prof. Code §2505 et seq. — Licensed Midwifery Practice Act (separate non-nurse LM credential, distinct from CNM; not independently fetched verbatim)
- Corp. Code §13401.5(f) — LM minority-ownership listing (secondary-sourced, not independently verified)
- SB 1237 (2020) — enacted the low-risk autonomy framework, eff. ~2021 (secondary-sourced; bill text not independently fetched)
- 16 CCR Article 6 (~§§1454-1464) — pre-SB-1237 CNM regulations; current status relative to §2746.5 unconfirmed, possible partial obsolescence
What a collaborating physician costs here
Typical monthly cost in California
$500 – $600
Estimate for one Certified Nurse-Midwife. Standard-tier state.
About California's rules
California's NPs reach genuine full independence (AB 890/SB 1451, ~6 years total) and CNMs need zero physician involvement for definitionally 'low-risk' pregnancy care — no hours threshold. NPs/PAs may also majority-own their own practice corporations (Corp. Code §13401.5), cutting against the assumption that CA's strict, actively-enforced CPOM regime (2026 AG settlements against Carbon Health, Aspen Dental) blocks all non-physician ownership. CRNA is order-based, not supervision-based. Esthetician laser use is a flat criminal misdemeanor — no delegation pathway exists.
Other clinicians in California: see the state overview.